- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,884.03 / $9,332.54
| Facility | | $1,202.26 | $2,884.03 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $16,218.10 / $31,622.78
| Facility | | $6,025.60 | $16,218.10 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $13,182.57
| Facility | | $7,413.10 | $12,022.64 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $6,165.95
| Professional | | $1,230.27 | $2,041.74 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,884.03 / $7,413.10
| Facility | | $575.44 | $2,884.03 | $7,413.10 |